Vaginismus is unique because it may result from a combination of physical or non-physical causes, or seem to have none at all.
Physical and Non-Physical Sources
What Causes Vaginismus?
Within the brain, there are a set of structures that perceive sensory information and control reactive bodily functions called the Limbic System. Although this system is still not fully understood by science, we know that involuntary vaginal tightening (vaginismus) is triggered by a limbic system overreaction. The various circumstances already discussed, ranging from unconsummated marriages to tightness experienced by women later in life, all result from this same common, resolvable overreaction. The involuntary muscle tightness occurs without conscious direction; the woman has not intentionally “caused” or directed her body to tighten and cannot simply make it stop without a resolution process.
Vaginal muscles tighten in overreaction when the limbic sensory system detects various forms of touch, pelvic vulnerability, or the negative anticipation of potential penetration. Some clinicians have described vaginismus as a fight or flight reaction in the pelvic floor and surrounding musculature. The body interprets signals incorrectly, responding with intense body tightening and reflexive movement away from potential penetration.
For women experiencing tightness later in life, after years of normal, pleasurable intercourse, the limbic overreaction typically develops through a vaginismus cycle-of-pain experience. At some point in their lives, either temporary pelvic issues or trauma causes the limbic system to be in heightened anxiety about the resumption of sex potentially causing pain or damage. For example, a woman who undergoes pelvic cancer surgery may have heightened underlying anxiety about her body not being fully healed from the stitches where an incision was made. The anxiety is less emotional and more of a complex body memory of recent trauma and tissue recovery pain. The limbic system senses the mix of general physical and internal emotional anxiety, and involuntarily causes the muscles in the pelvic floor to partially tighten to protect the area from pain or damage when attempts to resume intercourse begin. The partially tightened muscles cause intercourse attempts to be uncomfortable or painful, increasing the limbic system overreaction response and making the body overreact in the future with even greater tightening - an ongoing cycle of tightening and pain. The body develops a limbic response when it perceives that penetration is not safe, even though the physical or medical condition that originally triggered it may have been fully resolved. The mind and body learn to anticipate that what was once pleasurable is no longer safe.
Vaginismus Cycle of Pain
The Internal Alarm
The limbic system sounds an internal alarm, alerting the body of potential pain. Once triggered, the body automatically tightens the vaginal muscles, bracing to protect itself from harm.
Sex then becomes uncomfortable or painful, and entry may be more difficult or impossible depending upon the severity if this tightened state.
Additional sexual attempts result in discomfort, further reinforcing the limbic system response so that it intensifies more.
Finally, the body experiences increased pain and reacts by bracing more on an ongoing basis, further entrenching this response and creating a vaginismus cycle of pain.
As you read through the following lists, you may come to a better understanding of why your body is responding to intercourse as it is. However, please know that often the cause is not one single thing, but rather a result of many experiences and emotions, and as such the cause may never be completely understood. Fortunately, almost all women are able to overcome their penetration problem even without a clear understanding of what originally triggered it.
Examples of Non-Physical Causes
Fear or anticipation of intercourse pain, fear of not being completely physically healed following pelvic trauma, fear of tissue damage (ie "being torn"), fear of getting pregnant, concern that a pelvic medical problem may reoccur, etc.
Anxiety and Stress
General anxiety, performance pressures, previous unpleasant sexual experiences, negativity
Abuse, emotional detachment, fear of commitment, distrust, anxiety about being vulnerable, losing control, etc.
Past emotional / sexual abuse, witness of violence or abuse, repressed memories
Overly rigid parenting, unbalanced religious teaching (ie "Sex is BAD"), exposure to shocking sexual imagery, inadequate sex education
Sometimes there is no identifiable cause (physical or non-physical)
Examples of Physical Causes
Urinary tract infections or urination problems, yeast infections, sexually transmitted diseases, endometriosis, genital or pelvic tumors, cysts, cancer, vulvodynia / vestibulodynia, pelvic inflammatory disease, lichen, pains, lichen sclerosis, eczema, psoriasis, vaginal prolapse, etc.
Pain from normal or difficult vaginal deliveries and complications, c-sections, miscarriages, etc.
Menopause and hormonal changes, vaginal dryness / inadequate lubrication, vaginal atrophy
Temporary pain or discomfort resulting from insufficient foreplay, inadequate vaginal lubrication, etc.
Any type of pelvic surgery, difficult pelvic examinations, or other pelvic trauma
Physical attack, rape, sexual/physical abuse or assault
Side effects may cause pelvic pain
Did you know:
Vaginismus does not always have an obvious cause. Sometimes women with near perfect childhoods, great relationships, strong education, and few anxieties, have trouble finding any plausible explanation for what caused their vaginismus. Understanding why they had vaginismus may remain a mystery even after it is fully resolved. Fortunately, although it is helpful to know the causes, full knowledge is not necessary to complete successful treatment (see treatment kit).
Vaginismus is NOT the Woman's Fault
Since Vaginismus can be triggered by physical events as simple as having inadequate foreplay or lubrication, or non-physical emotions as simple as general anxiety, it is important that it be understood that vaginismus is not the woman's fault. Once triggered, the involuntary muscle tightness occurs without conscious direction; the woman has not intentionally 'caused' or directed her body to tighten and cannot simply make it stop. Women with vaginismus may initially be sexually responsive and deeply desire to make love but over time this desire may diminish due to pain and feelings of failure and discouragement. It is extremely frustrating to be unable to physically engage in pleasurable sexual intercourse.
Why do these causes trigger vaginismus in some women but not in others?
Life experiences vary dramatically from person to person. Some women's bodies react with vaginismus, while others with nearly identical experiences do not.
The anticipation of pain, emotional anxieties, or unhealthy sexual messages can contribute to and reinforce the symptoms of vaginismus. Frequently, but not always, there are deep-seated underlying negative feelings of anxiety associated with vaginal penetration. Emotional triggers that result in vaginismus symptoms are not always readily apparent and require some exploration. It is important that effective diagnosis and treatment processes include addressing any emotional triggers so a full pain-free and pleasurable sexual relationship can be enjoyed upon resolution.
Vaginismus with Other Medical Conditions
Vaginismus is often a complicating factor in the recovery from other pelvic pain conditions. Vaginismus may co-exist with other medical conditions, possibly triggered by temporary pelvic pain resulting from those conditions. Or, it can be the sole cause of sexual pain remaining after the original medical problems are addressed. When the underlying cause has been resolved or managed and ongoing pain, discomfort or penetration difficulties continue to remain, this is typically due to vaginismus.
In cases where there is clearly both vaginismus and another pelvic medical problem existing simultaneously, both problems will need to be treated to ensure full resolution. Without addressing the other medical condition, it will be difficult to resolve the vaginismus as it may continue to be triggered by pain from the other problem.